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March 1, 2018 -- VIENNA - Low breast cancer screening attendance rates plague capital cities and metropolitan areas. Researchers often cite high immigrant populations as the cause of this trend, but how accurate is that? A new study presented on Thursday at ECR 2018 reveals the truth behind the claim.

Dr. Sameer Bhargava from the research department at the Cancer Registry of Norway examined the attendance rate of immigrants and nonimmigrants in the population-based screening program of Norway. He and his colleagues checked the rates of attendance in Oslo and surrounding rural counties for both categories of women. They found low attendance rates for both immigrant and nonimmigrant women in Oslo; however, immigrant women did have even lower attendance rates.

"Efforts to increase attendance in urban areas should target both immigrants and other low-attending groups," Bhargava, who is also a doctoral student, told ECR 2018 delegates.

Background

Norwegian women ages 50 to 69 are invited to attend breast cancer screening biennially. Bhargava and colleagues culled attendance data from the cancer registry and Statistics Norway starting in 2005 with the capability of digging deeper into sociodemographic factors such as immigrant status, education, citizenship, etc. They defined immigrants as those born abroad with two foreign-born parents and four foreign-born grandparents.

The researchers selected breast cancer screening invitations sent to women living in counties with a low (< 5% of invitations sent to immigrants) or high proportion of immigrants (> 10% of invitations sent to immigrants). They identified Oslo as a high-proportion county and the rest of Norway as a low-proportion county. Women in the six low-proportion counties received 852,193 invitations, and women in Oslo received 277,229 invitations.

Low-density counties showed an attendance rate of 76.9% overall, while Oslo showed an attendance rate of 63.1% overall. In the breakdown of immigrant versus nonimmigrant, the numbers were even starker.

Nonimmigrant vs. immigrant attendance rates in Norway

Nonimmigrant

Immigrant

Oslo

67%

45%

Other counties

78%

57%

Using Oslo as a reference, adjusted rate ratios of attendance were 1.26 for immigrants and 1.16 for nonimmigrants in low-proportion counties. Adjusted rate ratios were 1.16 for immigrants and 1.14 for nonimmigrants.

"Attendance rates were lower for women in Oslo regardless of immigrant status," Bhargava said. "Attendance rates remained lower in the women in Oslo even after adjusting for sociodemographic factors. And adjusting for socioeconomic factors impacted immigrants more than nonimmigrants."

What can be done about it? Information is the key, according to Bhargava.

"We have to find out what information immigrants want to have about mammographic screening," he said. "And [whether we should] inform all women about mammographic screening in the same way."

Not all immigrants are the same -- women from Sweden might have different needs than women from Nigeria. Also, does breast cancer screening concern immigrant women? Some might perceive it as a more Western disease, given that breast cancer rates are higher in Europe and the U.S.